{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DANNY R CONARD SR","gend":0,"add":"107 MERRICKS COVE","city":"CALLANDS","state":"VA","zip":"24530-3000","dob":"1968-02-09","age":"","mstatus":"","insh":10128193,"cliId":"","pno":"4344212316, 4344212316","cno":"","email":"","ename":"","eno":"","pphy":"SHAH, MINESH R","ppno":"               ","pcpadd":"19144 HIGHTWAY 29 NORTH, ","pcpcity":"CHATHAM","pcpstate":"VA","pcpzip":245310001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP - VIRGINIA PREMIER","program":"MEDICAID","lob":"MLTSS","region":"WESTERN","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"107 MERRICKS COVE","madd2":"                                                            ","madd3":"","mcity":"CALLANDS","mstate":"VA","mzip":"24530-3000","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","K74.60","R53.83","J18.1","L89.159","K70.30","R62.7","J69.0","R53.1","J90","E43","L89.150","D68.4","B37.0","G62.9","L89.619","R13.10","R73.9","E86.0","G89.29","I10","R91.8","J98.4","J18.9","Z46.82","J86.9","F31.9","E44.0","F17.200","F41.1","M62.81","F31.81","R06.02","R91.1","K76.89","F31.75","D69.59","E87.1","E87.6","F10.21","M54.9","K59.09","N40.0","G47.00","F06.4","J20.9","K80.20","N20.2","R10.2","N20.1","E11.65","L60.0","M77.9","M79.674","M79.675","M79.671","L60.2","M54.5","R07.9","R10.13","K52.9","R33.9","D68.9","G31.9","R63.4","D64.9","S20.20XA","J98.11","R05","G89.4","F19.10","Z79.899","Z87.891","Z88.5","Z46.59","K76.6","R64","D63.8","R26.2","R26.81","R13.12","A08.39","D50.8","F44.5","F41.9","F17.203","R27.9","Z74.3","N40.1","R35.0","Z87.898","R39.14","R06.89","E78.5","Z12.5","R33.8","R68.89","L25.9","L21.9","R07.89","D69.6","Z12.11","R19.7","L89.329","L89.519","R09.89","Z23","B35.3","E11.39","H25.13","N20.0","R18.8","R16.1","I34.0","L30.9","K59.00","K70.31","F33.9","J02.9","F41.0","Z87.01"],"date":["2021-04-11","2020-03-06","2019-10-09","2019-02-16","2019-02-19","2020-01-01","2020-01-01","2020-09-29","2021-04-11","2019-05-07","2019-02-19","2019-05-01","2019-12-28","2019-02-12","2019-12-27","2019-02-12","2019-12-27","2019-02-12","2019-02-12","2019-12-28","2021-04-11","2019-12-27","2019-12-27","2019-02-24","2019-02-27","2019-05-01","2019-12-28","2019-05-01","2019-03-26","2019-04-30","2019-05-07","2021-05-24","2019-12-27","2020-01-01","2020-01-02","2020-01-01","2019-12-28","2020-01-01","2020-01-01","2019-12-28","2019-12-28","2019-12-28","2020-01-01","2020-01-06","2020-01-01","2019-12-30","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2021-04-08","2021-02-10","2020-05-27","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-04-11","2019-12-28","2019-02-12","2019-02-26","2019-05-01","2020-01-01","2019-02-20","2019-05-01","2019-12-27","2019-02-26","2019-02-26","2019-12-28","2019-12-28","2019-12-28","2019-02-11","2019-12-27","2021-04-11","2019-02-14","2019-02-20","2019-02-20","2019-02-20","2019-05-01","2019-05-01","2019-05-01","2019-05-01","2019-04-01","2019-05-01","2019-05-03","2019-03-01","2019-03-01","2019-03-01","2019-04-01","2019-04-01","2019-04-01","2019-04-01","2019-12-27","2021-04-11","2019-01-14","2019-04-01","2019-04-01","2019-04-30","2019-04-30","2020-01-01","2020-01-01","2020-03-06","2020-09-29","2019-02-19","2019-02-19","2019-02-24","2019-10-09","2021-02-10","2019-03-26","2019-03-26","2019-02-12","2019-02-12","2019-02-12","2019-02-13","2019-05-01","2019-05-01","2019-04-01","2019-05-01","2019-12-27","2019-12-27","2019-12-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877022310","GABAPENTIN ","CAP 300MG","90","Select","Select",""],["","69315090405","LORAZEPAM ","TAB 0.5MG","60","Select","Select",""],["","00228299611","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","49884021901","DOXEPIN ","CAP 50MG","30","Select","Select",""],["","00228203150","ALPRAZOLAM ","TAB 1MG","120","Select","Select",""],["","50111043303","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00172392760","DIAZEPAM ","TAB 10MG","60","Select","Select",""],["","00002751001","HUMALOG ","INJ 100\/ML","10","Select","Select",""],["","51672413101","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","00591555410","PROPRANOLOL ","TAB 10MG","90","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","13107005501","OXYCODONE ","TAB 5MG","180","Select","Select",""],["","54629060099","DOCUSATE ","CAP 100MG","60","Select","Select",""],["","10135013210","THIAMINE ","TAB 100MG","30","Select","Select",""],["","10147075005","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","41163042886","IRON ","TAB THERAPY","60","Select","Select",""],["","51645090501","VITAMIN ","0 MG TABLET","30","Select","Select",""],["","76204020025","ALBUTEROL ","NEB 0.00083","90","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","36","Select","Select",""],["","57664007110","FERROUS ","TAB 325MG","60","Select","Select",""],["","65862018730","ONDANSETRON ","TAB 4MG","18","Select","Select",""],["","00536510895","HYDROSKIN ","CRE 0.01","28","Select","Select",""],["","00172409660","BACLOFEN ","TAB 10MG","10","Select","Select",""],["","00603015032","DOCQLACE ","CAP 100MG","60","Select","Select",""],["","00168000480","TRIAMCINOLON ","CRE 0.001","80","Select","Select",""],["","00536106210","STOOL ","CAP 100MG","60","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","30","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","42806071405","BENZONATATE ","CAP 100MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}